'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Who

GPs across the country have reported PCTs breaking the rules by prying into practices' development plans, non-NHS work and accounts.

The news comes amid huge variations in policies for QOF visits, with some PCTs bringing in tougher scrutiny even of high performers while others go for lighter-touch monitoring than last year.

Dr Robert Morley, Birmingham LMC executive secretary, said PCTs in the city had taken a heavy-handed approach to QOF visits.

He said: 'They are going in depth in ways they shouldn't, to the extent that it would appear they are trying to carry out counter-fraud monitoring during these QOF visits.'

Heart of Birmingham PCT was 'named and shamed' by GPC chair Dr Hamish Meldrum at the annual LMCs conference in June for targeting GPs who scored below 750 points and calling them 'a cause for concern'.

The PCT confirmed lower achievers could still expect a more strident check.

Dr John Canning, Cleveland LMC secretary, said PCTs in his region were using QOF visits to snoop around GPs' ideas for providing private services and to delve into confidential practice business and development plans.

Some practices had rightly refused requests to divulge the information, he said: 'PCTs have to appreciate that the relationship is based on a formal legal contract and they have to follow the rules.'

Dr Brian Balmer, Essex LMC chief executive, said PCTs in the county were skirting around what was acceptable during visits.

Swale PCT in Kent has revealed plans to visit only those GPs who scored below 800 points.

Dr Gary Calver, Kent LMC secretary, said the 'arbitrary' policy had angered GPs: 'We would like the PCT to treat everybody equally.'

Westminster PCT said it was undertaking 'tougher scrutiny across the board'.

Dr Meldrum said he had expected practices to be treated with a lighter touch this year.

Monitoring needed to be sophisticated rather than 'taking an arbitrary figure and deciding that you are then going to be tougher on those people', he added.